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",{"id":215,"name":216},1,"Course previews",[218,229,234,239],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},302,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Troubleshooting radial access","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=5ehxLqt5fJU",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},12.533333333333333,"\u003Cp>Although the radial access route is becoming the preferred approach to femoral access in percutaneous coronary interventions (PCI), it does not come without its complications. In this video, Dr O'Brien will troubleshoot the radial access approach and offer his hard-won, expert advice to ensure that you learn how to perform a safe and effective procedure.\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},18.4,"Join our Percutaneous Coronary Intervention Essentials course today!","\u003Cp>Perform your own PCIs with our \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fpercutaneous-coronary-intervention-essentials\">Percutaneous Coronary Intervention Essentials\u003C\u002Fa> course. You’ll cover essential PCI equipment, lesion assessment, troubleshooting, and patient monitoring so that you can perform your own procedures under the supervision of an experienced cardiologist. This course will debunk common myths surrounding PCI patient selection so that you can offer it to more patients who need it.\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister\"> Get your FREE trial account\u003C\u002Fa> and start Chapter 1 now!\u003C\u002Fp>",{"type":230,"data":240},{"readDurationInSeconds":241,"title":242,"text":243},147.73333333333332,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:00:00] \u003C\u002Fb>Radial spasm is common and can cause issues with PCI and even angiography. It's more common in small arteries and in smokers, and it's provoked by excessive catheter movement or manipulation so aim to keep these down to a minimum. I mentioned earlier the use of an intraarterial anti-spasm cocktail, and this can help especially for new or inexperienced operators.\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:00:30] \u003C\u002Fb>Verapamil and nitrate are commonly used. Use concentrated drug and dilute it into the patient's blood aspirated into the syringe from the sheath as this is less irritant to the artery and less uncomfortable for the patient. Long sheath may help reduce spasm, but I don't use them very often in my standard daily practice. Hydrophilic catheters and sheathless guides may also be of use as these have\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:01:00]\u003C\u002Fb> a very slippery coating once wet. Sometimes, while small catheters will pass over the radial artery, it's not possible to advance a larger guiding catheter as the end of this is often more blunt and less tapered. It's sensible to give more radial cocktail and to reduce the chance of any spasm and also some sedation or pain relief will improve things for the patient and make passage of equipment easier. If this fails, one way of improving\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:01:30] \u003C\u002Fb>passage is to make the leading edge of the guiding catheter smoother. This is achieved as shown in the video by passing an angioplasty wire through the catheter and up the artery and inflating a small angioplasty balloon just out of the catheter to essentially produce a smooth structure to allow the catheter to track. This technique is known as balloon tracking. Notice the distal balloon markers positioned just outside the catheter before it's inflated\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:02:00] \u003C\u002Fb>which then allows the catheter to pass easily up the artery. Inadvertently, small branches can be entered and may even be large enough to take small diagnostic catheters especially\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:02:13] \u003C\u002Fb>catheters with very little angulation. It may then be difficult to advance a guiding catheter as these are much larger and blunter ending. And if the vessel is a small branch, this may not respond to antispasmodic and may result in dissection or\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:02:30] \u003C\u002Fb>perforation if you continue to push. Sometimes the J-wire and catheter go from the arm straight into the descending aorta rather than the aortic route or ascending aorta. If this happens, as you can see on the video, it's best to change to a left anterior oblique or LAO view, pull back the wire and catheter and use the catheter to redirect the wire into the aortic route. Sometimes it also helps to get the patient to take a deep breath enjoying this maneuver\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:03:00] \u003C\u002Fb>to straighten out the vessels and facilitate the correct placement. Remember, if you've caused an issue in accessing the radial artery, the patient may only bleed into the arm after the procedure once the guiding catheter is removed. This is due to the relatively smaller diameter of the radial artery, meaning that a large guiding catheter may have been covering or sealing the perforation or dissection whilst in place. The patient's then anticoagulated for the PCI\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:03:30]\u003C\u002Fb> and when the sealing action of the guiding catheter is taken away, the bleeding may be prompt. Apply firm further pressure to tampen out the leak at the puncture site. Fortunately, this is usually very easy to achieve for the radial artery in contrast to the femoral artery. If concerned then apply a manual sphygmomanometer cuff proximally and inflate higher than the last recorded systolic blood pressure to prevent blood flow into the arm and allow repositioning of pressure hemostasis\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:04:00] \u003C\u002Fb>devices distally. Elevate the arm in a Bradford sling above the level of the heart. Following PCI, it's important to check the distal pulses, evaluate capillary refill and general perfusion of the tissues and to monitor arterial waveforms noninvasively using pulse oximetry to confirm a good collateral circulation to the hand whilst the hemostasis device is in place. Watch for any signs of compartment syndrome including\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-95006db9-7fff-eb4c-a862-b247d735a2b2\">[00:04:30]\u003C\u002Fb> pain and skin changes. This is a serious but rare complication post PCI. With appropriate and careful monitoring, it can be caught and managed early.\u003C\u002Fp>",{"courses":245,"showAwardsBelow":48},[246],{"id":247,"isFreeCmeCourse":248,"title":249,"type":250,"specialization":251,"teachers":253,"cmeCredits":255,"teacherIllustration":256,"backgroundImage":257,"relativeUrl":258,"lastChanged":259,"created":260,"description":261,"relativeURL":258,"meta":262},6225,false,"Percutaneous Coronary Intervention Essentials","course",[252],"Cardiology",[254],"David G O’Brien, MD FRCP",6,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ee2-c18c-46fb-97fa-c3870c926ac5","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ee3-6401-420b-86b0-ea0adf25dab5","\u002Fcourses\u002Fpercutaneous-coronary-intervention-essentials","1763556345","1558283528","Perform your own percutaneous coronary interventions (PCI) with this step-by-step course. 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He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":296},"Internist",4,"\u002Fmagazine\u002Fstarting-statins-first-line-therapy",238,{"created":301,"updated":302,"published":303},1778960150,1779196374,1778961827,{"id":305,"title":306,"text":307,"image":308,"author":314,"path":316,"readDuration":317,"readDurationFormatted":318,"internal":319},1350,"How to recognize INOCA (ANOCA) on an exercise stress test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":309,"title":283,"size":310,"location":312},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).",{"width":311,"height":311},1200,{"bucket":287,"key":313},"\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":290,"title":291,"relativeURL":292,"image":293,"professionLong":294,"profession":315,"weight":297},{"name":296},"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":320,"updated":321,"published":322},1778115738,1778799792,1778118255,{"id":324,"title":325,"text":326,"image":327,"author":333,"path":335,"readDuration":336,"readDurationFormatted":337,"internal":338},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":328,"title":283,"size":329,"location":331},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":330,"height":330},600,{"bucket":287,"key":332},"\u002F2026-04\u002FC121_magazine image.png",{"id":290,"title":291,"relativeURL":292,"image":293,"professionLong":294,"profession":334,"weight":297},{"name":296},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":339,"updated":340,"published":341},1777403036,1777572381,1777412421,{"seo":343,"og":345},{"title":344,"description":213},"PCI—troubleshooting radial access | Medmastery",{"title":344,"description":213,"image":346},{"alt":283,"title":283,"size":347,"location":350},{"width":348,"height":349},663,377,{"bucket":287,"key":351},"\u002Fmigrated-images\u002FScreen Shot 2019-06-28 at 2.03.51 pm.png",{"id":353,"created":354,"updated":355,"published":354},311,1562841835,1655189586]